Advanced da Vinci Surgical System simulator for surgeon training and operation planning

A novel affordable user interface for robotic surgery training: design, development and usability study

Introduction

The use of robotic systems in the surgical domain has become groundbreaking for patients and surgeons in the last decades. While the annual number of robotic surgical procedures continues to increase rapidly, it is essential to provide the surgeon with innovative training courses along with the standard specialization path. To this end, simulators play a fundamental role. Currently, the high cost of the leading VR simulators limits their accessibility to educational institutions. The challenge lies in balancing high-fidelity simulation with cost-effectiveness; however, few cost-effective options exist for robotic surgery training.

Methods

This paper proposes the design, development and user-centered usability study of an affordable user interface to control a surgical robot simulator. It consists of a cart equipped with two haptic interfaces, a VR visor and two pedals. The simulations were created using Unity, which offers versatility for expanding the simulator to more complex scenes. An intuitive teleoperation control of the simulated robotic instruments is achieved through a high-level control strategy.

Results and Discussion

Its affordability and resemblance to real surgeon consoles make it ideal for implementing robotic surgery training programs in medical schools, enhancing accessibility to a broader audience. This is demonstrated by the results of an usability study involving expert surgeons who use surgical robots regularly, expert surgeons without robotic surgery experience, and a control group. The results of the study, which was based on a traditional Peg-board exercise and Camera Control task, demonstrate the simulator's high usability and intuitive control across diverse user groups, including those with limited experience. This offers evidence that this affordable system is a promising solution for expanding robotic surgery training.

Exploring the Impact of Hand Dominance on Laparoscopic Surgical Skills Development Using Network Models

BACKGROUND

Laparoscopic surgery demands high precision and skill, necessitating effective training protocols that account for factors such as hand dominance. This study investigates the impact of hand dominance on the acquisition and proficiency of laparoscopic surgical skills, utilizing a novel assessment method that combines Network Models and electromyography (EMG) data.

METHODS

Eighteen participants, comprising both medical and non-medical students, engaged in laparoscopic simulation tasks, including peg transfer and wire loop tasks. Performance was assessed using Network Models to analyze EMG data, capturing muscle activity and learning progression. The NASA Task Load Index (TLX) was employed to evaluate subjective task demands and workload perceptions.

RESULTS

Our analysis revealed significant differences in learning progression and skill proficiency between dominant and non-dominant hands, suggesting the need for tailored training approaches. Network Models effectively identified patterns of skill acquisition, while NASA-TLX scores correlated with participants' performance and learning progression, highlighting the importance of considering both objective and subjective measures in surgical training.

CONCLUSIONS

The study underscores the importance of hand dominance in laparoscopic surgical training and suggests that personalized training protocols could enhance surgical precision, efficiency, and patient outcomes. By leveraging advanced analytical techniques, including Network Models and EMG data analysis, this research contributes to optimizing clinical training methodologies, potentially revolutionizing surgical education and improving patient care.

Preoperative planning of three axis intersection surgical laparoscopic arm system based on characteristic parameters

PURPOSE

The application of robotics in the field of minimally invasive surgery solves some shortcomings of traditional minimally invasive surgery. Preoperative planning is an important prerequisite for the successful completion of robot-assisted surgery. The optimization of surgical incision position and the initial location of surgical robot are two important parts of preoperative planning. In this paper, a novel structure and preoperative planning method of a three-axis intersection surgical manipulator are proposed.

METHODS

Firstly, a mathematical model of human abdominal wall was established. Three characteristic parameters between the lesion and the incision are defined and used to optimize the surgical incisions. Then, the spatial position relationship between the laparoscopic arm and the incision was analyzed to obtain the effective solution groups of each passive joint of the laparoscopic arm. Lastly, the optimal initial location of the laparoscopic arm was determined by taking the total joint variables of the telecentric mechanism as the optimization index.

RESULTS

According to a given set of lesion parameters and the position of laparoscopic arm base, the optimal incision position was obtained using the surgical incision characteristic parameters and the optimal triangle criterion, and the positioning angles of the laparoscopic arm were optimized by using the Total Joint Variable (TJV) as the evaluation index.

CONCLUSIONS

The proposed preoperative planning method is verified by simulation. The proposed method can realize the preoperative planning process of the three axis intersection laparoscopic arm. The proposed method of preoperative planning will provide important reference to improve the intelligence of robot-assisted surgery.

Autonomous sequential surgical skills assessment for the peg transfer task in a laparoscopic box-trainer system with three cameras

In laparoscopic surgery, surgeons should develop several manual laparoscopic skills before carrying out real operative procedures using a low-cost box trainer. The Fundamentals of Laparoscopic Surgery (FLS) program was developed as a program to assess fundamental knowledge and surgical skills, required for basic laparoscopic surgery. The peg transfer task is a hands-on exam in the FLS program that assists a trainee to understand the relative minimum amount of grasping force necessary to move the pegs from one place to another place without dropping them. In this paper, an autonomous, sequential assessment algorithm based on deep learning, a multi-object detection method, and, several sequential If-Then conditional statements have been developed to monitor each step of a surgeon’s performance. Images from three different cameras are used to assess whether the surgeon executes the peg transfer task correctly and to display a notification on any errors on the monitor immediately. This algorithm improves the performance of a laparoscopic box-trainer system using top, side, and front cameras and removes the need for any human monitoring during a peg transfer task. The developed algorithm can detect each object and its status during a peg transfer task and notifies the resident about the correct or failed outcome. In addition, this system can correctly determine the peg transfer execution time, and the move, carry, and dropped states for each object by the top, side, and front-mounted cameras. Based on the experimental results, the proposed surgical skill assessment system can identify each object at a high score of fidelity, and the train-validation total loss for the single-shot detector (SSD) ResNet50 v1 was about 0.05. Also, the mean average precision (mAP) and Intersection over Union (IoU) of this detection system were 0.741, and 0.75, respectively. This project is a collaborative research effort between the Department of Electrical and Computer Engineering and the Department of Surgery, at Western Michigan University.

Effect of button layout on the exploration and learning of robot operation using an unfamiliar controller

Robots are becoming increasingly accessible to both experts and non-experts. Therefore, establishing a method for learning robot operations that can be easily mastered by non-experts is important. With this in mind, we aimed to develop a method that facilitates skill acquisition for non-experts that operate robots. As a first step, this study examined the effects of button layout on the exploration and learning of robot operations. A humanoid robot was operated using an unfamiliar tablet-based user interface to achieve the task of shifting the robot’s posture to the desired posture: single-foot-standing. The process in which participants found and repeated sequences of commands to achieve the shift task was observed. Four types of button layouts were prepared: normal, random, name appears after the first success (NAFS), and change to normal controller after the first success (CNFS). The normal layout roughly matched the position of the robot’s joints, whereas the random layout was randomly assigned, and no information was displayed on each button. Before completing the shift task, a random layout was provided in the NAFS and CNFS layouts. After the first success, the corresponding joint information was displayed in the NAFS layout, whereas the layout was changed to a normal one in the CNFS layout. In total, 51 participants used the normal layout, 7 participants used the random layout, 25 participants used the NAFS layout, and 24 participants used the CNFS layout. The results indicate that providing a random layout during the exploration process (before the first success) is preferable for effective exploration and learning. However, during the learning process (after the first success), providing the relationship between joint movements and buttons in a visual manner is better without changing the button layout from that used in the exploration process.

Preoperative planning method based on a MOPSO algorithm for robot-assisted cholecystectomy

PURPOSE

Surgical robots have multiple manipulators with complex mechanisms and need to work in a narrow space in the patient's body. Therefore, for robot-assisted minimally invasive surgery (RMIS), it is very important to develop a reasonable preoperative planning before surgery.

METHODS

A preoperative planning method based on the premise of no collision between surgical instruments and endoscope, an evaluation index with visibility, operability and hand-eye coordination was proposed in this paper. To consider the balance relationship of global optimization index, a multi-objective particle swarm optimization (MOPSO) algorithm was adopted. Because the physical characteristics of each patient are different, the method can determine the selectable area of the incision based on the relevant knowledge of anatomy.

RESULTS

The simulation taking the cholecystectomy as an example was performed on a minimally invasive surgical robotic system. The analysis result showed that the proposed preoperative planning method based on the MOPSO could provide surgeons with a reasonable and effective preoperative planning.

CONCLUSIONS

The proposed preoperative planning method based on the MOPSO is suitable for patients with different physical characteristics, and can provide a guidance for surgeons and effectively reduce the preoperative planning time and improve the safety and efficiency of the operation, especially a novice surgeon who lacks robot-assisted minimally invasive surgery experience.

Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.

Preoperative Computer-Assisted Laparoscopy Planning for the Minimally Invasive Surgical Repair of Hiatal Hernia

Minimal invasive surgical procedures such as laparoscopy are preferred over open surgery due to faster postoperative recovery, less trauma and inflammatory response, and less scarring. Laparoscopic repairs of hiatal hernias require pre-procedure planning to ensure appropriate exposure and positioning of the surgical ports for triangulation, ergonomics, instrument length and operational angles to avoid the fulcrum effect of the long and rigid instruments. We developed a novel surgical planning and navigation software, iMTECH to determine the optimal location of the skin incision and surgical instrument placement depth and angles during laparoscopic surgery. We tested the software on five cases of human hiatal hernia to assess the feasibility of the stereotactic reconstruction of anatomy and surgical planning. A whole-body CT investigation was performed for each patient, and abdominal 3D virtual models were reconstructed from the CT scans. The optical trocar access point was placed on the xipho-umbilical line. The distance on the skin between the insertion point of the optical trocar and the xiphoid process was 159.6, 155.7, 143.1, 158.3, and 149.1 mm, respectively, at a 40° elevation angle. Following the pre-procedure planning, all patients underwent successful surgical laparoscopic procedures. The user feedback was that planning software significantly improved the ergonomics, was easy to use, and particularly useful in obese patients with large hiatal defects where the insertion points could not be placed in the traditional positions. Future studies will assess the benefits of the planning system over the conventional, empirical trocar positioning method in more patients with other surgical challenges.

Predictive Validation of a Robotic Virtual Reality Simulator: The Tube 3 module for Practicing Vesicourethral Anastomosis in Robot-Assisted Radical Prostatectomy

OBJECTIVE

To predict actual performance in real surgery when vesicourethral anastomosis (VUA) is performed in patients after Tube 3 module training of robot-naive surgeons.

METHODS

Forty-five patients were enrolled and divided into 3 groups according to chronological trends (each containing 15 patients). Three robot-naive surgeons in a single center completed VUA in robot-assisted radical prostatectomy (RARP) following robotic virtual reality simulator (RVRS) training. The practicing tool used in robotic virtual reality simulator was Tube 3, which was invented for the dV-Trainer that imitates a VUA in RARP. The effects of performance were investigated by analyzing the number of repetitions and the time required to complete the task until achieving the predetermined proficiency level.

RESULTS

The targeted time (predetermined proficiency level) for completing tasks of Tube 3 and the number of required task repetitions to achieve the proficiency level were 283.1 s and 36 times, respectively, whereas in actual VUA procedures, the number of required attempts was 24, with an average time of 14.9 minutes. The mean time for completing VUA in real surgery significantly decreased with serial cases among all surgeons (1-15 vs 16-30 vs 31-45 cases, P <.001), as well as comparisons between groups (P <.001).

CONCLUSION

The Tube 3 module can represent a valuable educational tool for procedure-specific robotic training by bridging the gap between safe acquisition of surgical skills and effective performance during actual VUA in RARP.

Error reporting from the da Vinci surgical system in robotic surgery: A Canadian multispecialty experience at a single academic centre

INTRODUCTION

The goal of the study is to evaluate and report on the third-generation da Vinci surgical (Si) system malfunctions.

METHODS

A total of 1228 robotic surgeries were performed between January 2012 and December 2015 at our academic centre. All cases were performed by using a single, dual console, four-arm, da Vinci Si robot system. The three specialties included urology, gynecology, and thoracic surgery. Studied outcomes included the robotic surgical error types, immediate consequences, and operative side effects. Error rate trend with time was also examined.

RESULTS

Overall robotic malfunctions were documented on the da Vinci Si systems event log in 4.97% (61/1228) of the cases. The most common error was related to pressure sensors in the robotic arms indicating out of limit output. This recoverable fault was noted in 2.04% (25/1228) of cases. Other errors included unrecoverable electronic communication-related in 1.06% (13/1228) of cases, failed encoder error in 0.57% (7/1228), illuminator-related in 0.33% (4/1228), faulty switch in 0.24% (3/1228), battery-related failures in 0.24% (3/1228), and software/hardware error in 0.08% (1/1228) of cases. Surgical delay was reported only in one patient. No conversion to either open or laparoscopic occurred secondary to robotic malfunctions. In 2015, the incidence of robotic error rose to 1.71% (21/1228) from 0.81% (10/1228) in 2014.

CONCLUSIONS

Robotic malfunction is not infrequent in the current era of robotic surgery in various surgical subspecialties, but rarely consequential. Their seldom occurrence does not seem to affect patient safety or surgical outcome.

Domestically produced Chinese minimally invasive surgical robot system "Micro Hand S" is applied to clinical surgery preliminarily in China

OBJECTIVE

To develop and validate one low-cost and easy-use domestically produced Chinese minimally invasive surgical robot system "Micro Hand S" that surgeons can use to resolve the complicated surgeries challenge.

METHODS

From April 2014 to April 2015, one patient with gastric perforation, three patients with acute appendicitis, five patients with acute cholecystitis, and one patient with right colon cancer underwent robotic-assisted surgeries. Eight of these patients were followed for 1 month, and pre- and postoperative changes in blood route test and hepatorenal function examination, surgery duration, hospital stay, total robotic setup time, total robotic operation time, intraoperative blood loss, total postoperative drainage amount, duration of bearing drainage tubes were recorded. Two patients withdrew from the study because of individual privacies.

RESULTS

We accomplished surgical procedures using "Micro Hand S." No intraoperative complications or technical problems were encountered. All patients recovered and discharged from hospital without complications.

CONCLUSIONS

The domestic surgical robot system "Micro Hand S" was validated as safe and effective through these clinical cases. The proposed design method is an effective way to make "Micro Hand S" become low-cost and easy-use robot system.

Current state of virtual reality simulation in robotic surgery training: a review

BACKGROUND

Worldwide, the annual number of robotic surgical procedures continues to increase. Robotic surgical skills are unique from those used in either open or laparoscopic surgery. The acquisition of a basic robotic surgical skill set may be best accomplished in the simulation laboratory. We sought to review the current literature pertaining to the use of virtual reality (VR) simulation in the acquisition of robotic surgical skills on the da Vinci Surgical System.

MATERIALS AND METHODS

A PubMed search was conducted between December 2014 and January 2015 utilizing the following keywords: virtual reality, robotic surgery, da Vinci, da Vinci skills simulator, SimSurgery Educational Platform, Mimic dV-Trainer, and Robotic Surgery Simulator. Articles were included if they were published between 2007 and 2015, utilized VR simulation for the da Vinci Surgical System, and utilized a commercially available VR platform.

RESULTS

The initial search criteria returned 227 published articles. After all inclusion and exclusion criteria were applied, a total of 47 peer-reviewed manuscripts were included in the final review.

CONCLUSIONS

There are many benefits to utilizing VR simulation for robotic skills acquisition. Four commercially available simulators have been demonstrated to be capable of assessing robotic skill. Three of the four simulators demonstrate the ability of a VR training curriculum to improve basic robotic skills, with proficiency-based training being the most effective training style. The skills obtained on a VR training curriculum are comparable with those obtained on dry laboratory simulation. The future of VR simulation includes utilization in assessment for re-credentialing purposes, advanced procedural-based training, and as a warm-up tool prior to surgery.

A novel teaching system for industrial robots

The most important tool for controlling an industrial robotic arm is a teach pendant, which controls the robotic arm movement in work spaces and accomplishes teaching tasks. A good teaching tool should be easy to operate and can complete teaching tasks rapidly and effortlessly. In this study, a new teaching system is proposed for enabling users to operate robotic arms and accomplish teaching tasks easily. The proposed teaching system consists of the teach pen, optical markers on the pen, a motion capture system, and the pen tip estimation algorithm. With the marker positions captured by the motion capture system, the pose of the teach pen is accurately calculated by the pen tip algorithm and used to control the robot tool frame. In addition, Fitts' Law is adopted to verify the usefulness of this new system, and the results show that the system provides high accuracy, excellent operation performance, and a stable error rate. In addition, the system maintains superior performance, even when users work on platforms with different inclination angles.

Validation of a novel virtual reality simulator for robotic surgery

Objective. With the increase in robotic-assisted laparoscopic surgery there is a concomitant rising demand for training methods. The objective was to establish face and construct validity of a novel virtual reality simulator (dV-Trainer, Mimic Technologies, Seattle, WA) for the use in training of robot-assisted surgery. Methods. A comparative cohort study was performed. Participants (n = 42) were divided into three groups according to their robotic experience. To determine construct validity, participants performed three different exercises twice. Performance parameters were measured. To determine face validity, participants filled in a questionnaire after completion of the exercises. Results. Experts outperformed novices in most of the measured parameters. The most discriminative parameters were “time to complete” and “economy of motion” (P < 0.001). The training capacity of the simulator was rated 4.6 ± 0.5 SD on a 5-point Likert scale. The realism of the simulator in general, visual graphics, movements of instruments, interaction with objects, and the depth perception were all rated as being realistic. The simulator is considered to be a very useful training tool for residents and medical specialist starting with robotic surgery. Conclusions. Face and construct validity for the dV-Trainer could be established. The virtual reality simulator is a useful tool for training robotic surgery.

A semi-infinite programming approach to preoperative planning of robotic cardiac surgery under geometric uncertainty

In this paper, a computational framework for patient-specific preoperative planning of Robotics-Assisted Minimally Invasive Cardiac Surgery (RAMICS) is presented. It is expected that preoperative planning of RAMICS will improve the success rate by considering robot kinematics, patient-specific thoracic anatomy, and procedure-specific intraoperative conditions. Given the significant anatomical features localized in the preoperative computed tomography images of a patients thorax, port locations and robot orientations (with respect to the patients body coordinate frame) are determined to optimize qualities such as dexterity, reachability, tool approach angles and maneuverability. To address intraoperative geometric uncertainty, the problem is formulated as a Generalized Semi-Infinite Program (GSIP) with a convex lower-level problem to seek a plan that is less sensitive to geometric uncertainty in the neighborhood of surgical targets. It is demonstrated that with a proper formulation of the problem, the GSIP can be replaced by a tractable constrained nonlinear program that uses a multi-criteria objective function to balance between the nominal task performance and robustness to collisions and joint limit violations. Finally, performance of the proposed formulation is demonstrated by a comparison between the plans generated by the algorithm and those recommended by an experienced surgeon for several case studies.

Pilot study on effectiveness of simulation for surgical robot design using manipulability

Medical technology has advanced with the introduction of robot technology, which facilitates some traditional medical treatments that previously were very difficult. However, at present, surgical robots are used in limited medical domains because these robots are designed using only data obtained from adult patients and are not suitable for targets having different properties, such as children. Therefore, surgical robots are required to perform specific functions for each clinical case. In addition, the robots must exhibit sufficiently high movability and operability for each case. In the present study, we focused on evaluation of the mechanism and configuration of a surgical robot by a simulation based on movability and operability during an operation. We previously proposed the development of a simulator system that reproduces the conditions of a robot and a target in a virtual patient body to evaluate the operability of the surgeon during an operation. In the present paper, we describe a simple experiment to verify the condition of the surgical assisting robot during an operation. In this experiment, the operation imitating suturing motion was carried out in a virtual workspace, and the surgical robot was evaluated based on manipulability as an indicator of movability. As the result, it was confirmed that the robot was controlled with low manipulability of the left side manipulator during the suturing. This simulation system can verify the less movable condition of a robot before developing an actual robot. Our results show the effectiveness of this proposed simulation system.

Face, content and construct validity of a virtual reality simulator for robotic surgery (SEP Robot)

INTRODUCTION

This study aims to establish face, content and construct validation of the SEP Robot (SimSurgery, Oslo, Norway) in order to determine its value as a training tool.

SUBJECTS AND METHODS

The tasks used in the validation of this simulator were arrow manipulation and performing a surgeon's knot. Thirty participants (18 novices, 12 experts) completed the procedures.

RESULTS

The simulator was able to differentiate between experts and novices in several respects. The novice group required more time to complete the tasks than the expert group, especially suturing. During the surgeon's knot exercise, experts significantly outperformed novices in maximum tightening stretch, instruments dropped, maximum winding stretch and tool collisions in addition to total task time. A trend was found towards the use of less force by the more experienced participants.

CONCLUSIONS

The SEP robotic simulator has demonstrated face, content and construct validity as a virtual reality simulator for robotic surgery. With steady increase in adoption of robotic surgery world-wide, this simulator may prove to be a valuable adjunct to clinical mentorship.

Training and learning robotic surgery, time for a more structured approach: a systematic review

BACKGROUND

Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons.

OBJECTIVES

To review the literature on training and learning strategies for robotic assisted laparoscopic surgery.

SEARCH STRATEGY

A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed.

SELECTION CRITERIA

We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism.

DATA COLLECTION AND ANALYSIS

Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation.

MAIN RESULTS

We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme.

AUTHORS' CONCLUSIONS

Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes.

Control design and implementation of a novel master-slave surgery robot system, MicroHand A

BACKGROUND

Compared with conventional minimally invasive surgery and open surgery, robotic-assisted minimally invasive surgery can overcome or eliminate drawbacks caused by operator restrictions, motion limitation by the trocar and the image system, such as fatigue, trembling, low precision, constrained degree-of-freedom, poor hand-eye coordination and restricted surgical vision. In this paper, a novel partly tendon-driven master-slave robot system is proposed to assist minimally invasive surgery and a master-slave control architecture is developed for abdominal surgical operations.

METHODS

A novel master-slave surgery robot system named MicroHand A has been developed. A kinematic analysis of master and slave manipulators was conducted, based on screw theory and vector loop equation. The relationships of the tendon-driven multi-DOF surgical instrument among Cartesian space, actuator space and joint space were derived for control purposes. The control system architecture of the MicroHand A was designed with intuitive motion control and motion scaling control. Llewellyn's absolute stability criterion and the transparency of the one-DOF master-slave system are also analysed.

RESULTS

Intuitive motion control under dissimilar kinematics in master-slave manipulations and motion scaling control were accomplished to solve absonant hand-eye coordination, kinematic dissimilarity and workspace mismatch of master-slave manipulator problems. A series of tests and animal experiments were carried out to evaluate system performance. The experimental results demonstrate that the system could accomplish intuitive motion control and motion scaling control, and that the control system is stable and reliable.

CONCLUSIONS

The experiments performed on the MicroHand A robotic system yielded expected control results. The system satisfies the requirements of minimally invasive surgery. Intuitive motion control and motion scaling control under different kinematics for the master and slave have been implemented.

Randomized controlled trial of virtual reality and hybrid simulation for robotic surgical training

OBJECTIVE

To evaluate if two commonly used laparoscopic simulators could be adapted and used successfully for the robotics platform in a laparoscopic and robotic naïve medical student population.

MATERIALS AND METHODS

We identified two widely validated laparoscopic simulation programs, LapSim(®) (Surgical Science Sweden AB), and ProMIS(®) (Haptica, Ireland)for inclusion in the study. The McGill Inanimate System for Training and Evaluation of Laparoscopic Skills(®) task set was used for ProMIS, and adapted for the DaVinci(®) console (Intuitive Surgical, Inc., Sunnyvale, CA, USA) robotic platform. We then randomized 20 naïve medical students to receive training on either LapSim or ProMIS, both or neither, and evaluated them before and after training.

RESULTS

When the groups were compared at baseline, there were no statistical differences in mean scores amongst the groups in univariate analysis (α= 0.05). When comparing mean scores within groups before and after training sessions, statistically significant performance enhancement in all four robotic tasks were identified in the groups receiving dual training.

CONCLUSION

We have shown that the use of ProMIS hybrid and LapSim virtual reality (VR) simulators in conjunction with each other can considerable improve robotic console performance in novice medical students compared with hybrid and VR simulation alone.